Provider Demographics
NPI:1659148005
Name:SHEPPARD, MONIQUE QUAMIESHA
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:QUAMIESHA
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GRANDVIEW FOREST DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-3405
Mailing Address - Country:US
Mailing Address - Phone:984-291-9176
Mailing Address - Fax:
Practice Address - Street 1:200 GRANDVIEW FOREST DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-3405
Practice Address - Country:US
Practice Address - Phone:984-291-9176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician